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GMB’S CASE TO GOVERNMENT
CONTENTS

 FOREWORD                  2
 EXECUTIVE SUMMARY         3
 INTRODUCTION              4
 CHAPTER 1 - BACKGROUND    6
 CHAPTER 2 - IMPACT
 ON WORKERS                10
 CHAPTER 3 - EQUALITY
 AND REGIONAL ANALYSIS
                           16

 CHAPTER 4 - BREXIT        19
 CHAPTER 5 - THE COST OF
 ENDING THE PAY PINCH      22
 APPENDIX                  25
 ENDNOTES                  28
FOREWORD

Seven years into the public sector pay squeeze and our worst fears have been realised.

Real terms cuts to public sector pay aren’t just failing our members.

They’re failing everyone who relies on our vital public services.

This report sets out how the pay cap and funding cuts have created a recruitment and
retention crisis. We all end up paying more in the end.

Ministers like to talk about pay ‘restraint’ – as if George Osborne had to be held back from
properly paying our nurses, teaching assistants and refuse workers.

Let’s call the policy what it really is – a deep cut to our members’ quality of living.

The financial crash wasn’t caused by teaching assistants, council officers or hospital
porters. It’s outrageous that they are still expected to pay the price for the banking crisis
over a decade later.

The policy has already cost our members thousands of pounds in lost earnings. Enough is
enough.

Theresa May and Philip Hammond now have a chance to break with the failed policies of
their predecessors, and make sure that helping those ‘just about managing’ actually means
something to the UK’s five million strong army of public sector workers.

This isn’t just in our members’ best interests. It’s in the best interests of the country as a
whole.

The UK’s public services keep the country on the road. Public sector workers already do more
than anyone could reasonably ask.

That’s why GMB stands with them, and it is why we will not rest until we have secured the
decent pay deals our members need and deserve.

Rehana Azam
National Secretary, Public Services Section, GMB

                                                2
EXECUTIVE SUMMARY

• The Government’s pay constraint policy is not only unfair on individual workers,
  it is failing on its own terms. The cap has already been breached in strategic areas.
  Recruitment and retention problems are mounting as the pressure on public services rises.
  75% of voters support an end to the cap, and the challenges posed by Brexit mean that the
  assumptions the policy was based on are no longer valid (Chapter 1).

• The average public/private sector pay gap is no longer significant, and public services
  will be seriously harmed if the pay differential is allowed to fall any further. There is a
  strong body of evidence that links private sector competition for public sector staff to
  worse outcomes in our schools and hospitals (Chapter 2).

• Public sector workers have suffered severe real-terms cuts to their salaries. The
  average NHS wage for workers on the top of their pay bands has increased by just 3% since
  2010 - less than a third of average pay growth in the private sector. This is contributing to
  severe recruitment and retention challenges across the public sector (Chapter 4).

• The equalities impacts of the public sector pay freeze have been downplayed. Women
  are especially likely to be affected by constraints on public sector pay and cuts to public
  sector jobs. The gender pay gap within the public sector has actually widened in recent
  years, and the policy has had an especially negative affect in England outside London and
  the South East (Chapter 5).

• The Government’s preparations for Brexit are placing additional strains on our public
  services which are compounded by the public sector pay cap. The extra inflation
  projected to be created by Brexit will cost the average public sector worker over a
  thousand pounds in real wage losses. Without adequate training places and improved
  workforce retention, new restrictions on immigration could have a severe impact on some
  public services (Chapter 6).

• Ending the public sector pay cap in this Parliament is both realistic and affordable.
  GMB has set out a range of options for how the Government could fund an early end to the
  policy (Chapter 7).

• Public sector workers are facing a pay squeeze that is unprecedented in modern
  history. The real term cuts to public sector wages are even more severe and prolonged
  than pay restrictions in the 1990s (Appendix).

                                      END THE

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                                               3
INTRODUCTION

Since 2010 public sector workers have been           Public sector labour markets are complex
subjected to an unprecedented squeeze on             entities that need flexibility to adapt to
their wages.                                         rising demand. By contrast, the pay cap is an
                                                     inexact instrument that has inflicted a blunt
A planned decade of deep, real terms cuts            force trauma on the nation’s public sector.
to wages is driving people out of their
professions and undermining the quality of           There is compelling evidence that poor pay
public services for everyone.                        differentials between public and private
                                                     sectors are associated with declining
This is why the GMB is calling on Ministers to       standards, such as worsened exam results
take four steps:                                     and hospital fatality rates.

• No ifs, no buts – an end to public sector          It is vital that the ability of Pay
  pay cuts                                           Review Bodies to make independent
• Proper funding for public services                 recommendations is restored on the basis of
• Restoration of independence for the Pay            need, not an arbitrary cap.
  Review Bodies
• A real Living Wage of at least £10 an              This report is based on a variety of sources,
  hour for all public sector workers.                including testimony from our members,
                                                     official statistics and information obtained
Alongside the need to reduce the deficit,            from the Treasury under the Freedom of
the Government has defended the policy on            Information Act. However, the available
two grounds: that public sector pay remains          material is uneven in nature.
attractive compared to the private sector,
and that its pay policy has protected the            Comparably good information is available
total number of public sector jobs (especially       on the labour market in NHS, although the
for women).                                          quality of the data is generally lessened for
                                                     roles at the lower end of the pay scale. The
This report argues that this defence                 same cannot be said for school workers who
cannot be sustained. The Government’s                are not teachers.
pay constraint policy is not only unfair on
individual workers, it is failing on its own         The Government collects only the most basic
terms. The cap has already been breached in          data in this area, and following the scrapping
strategic areas.                                     of the School Support Staff Negotiating Body
                                                     in 2010 there is no independent source of pay
Recruitment and retention problems are               information at a national level.
mounting as pressures on public services
rises. The challenges posed by Brexit and            Similarly, leaver and joiner rates are
inflation mean that the assumptions the              published for police officers but not other
policy was based on are no longer valid.             police staff.1
                                                 4
Ministers do not collect data on the wastage          As this report sets out, ending the pay cap is
and turnover rates for Local Government               both practical and affordable. It is time for
workers, despite the impact of Central                the Government give public sector workers
Government’s policies on Local Government             the real pay rise that they deserve.
staff.

When it comes to policy making at a senior
level, it is difficult to resist the conclusion
that some grades of workers are out of sight,
and out of mind.

GMB believes that our public services cannot
succeed without the contributions of all
their workers – teaching assistants as well
as teachers, hospital cleaners as well as
consultants.

Within the constraints of the Government’s
approach to information collection, this
report attempts to redress the balance by
examining the impact of the pay squeeze on
groups of public sector workers that do not
typically receive national attention, including
over six hundred thousand school support
staff employees.

The limitations of the available data
do, however, underline the need for the
restoration of the School Support Staff
Negotiating Body and better information
collection across the public sector as a whole.

GMB strongly supports the TUC’s public
sector pay campaign2, as well as the ETUC’s
wider ‘Year of the Pay Rise’ campaign3, and
this report is intended to add another voice
to the growing calls for change.

The pay cap is hurting, but it is not working.
We have reached the point where the policy
cannot be continued without impairing
productivity gains.

Recruitment and retention challenges are
present across the sector, but in some areas
they are at boiling point.
                                                  5
CHAPTER 1 - BACKGROUND

                       “Our economy should work for everyone, but
                       if your pay has stagnated for several years in a
                       row and fixed items of spending keep going up,
                       it doesn’t feel like it’s working for you.”

                       Theresa May, October 2016

Policy and political background                     scrapped.

Public sector workers are now entering              Even this mitigation fell short of
their seventh year of deep, real-terms pay          expectations, as the £250 increase was not
cuts. This squeeze on living standards is           automatically applied to ‘non-Crown’ public
unprecedented in the modern era. The only           sector employees such as Local Government
comparable period was under John Major,             staff and academy employees.
when pay constraints contributed to the
perception and reality of public services in        Although the cap does not directly apply to
deep decline (this issue is discussed further       all public sector workers, in practice it has
in the Appendix).                                   been followed across the sector in all but
                                                    exceptional cases.
Despite the severity of the cap, a prolonged,
restrictive cap on public sector pay                The impact of the policy has been more
has never been put to voters. The 2010              severe in some parts of the sector: in the
Conservative Manifesto proposed a one year          early part of the last Parliament, Local
pay freeze with an exemption for the million        Government staff effectively faced three
lowest paid public sector workers.4                 years of absolute freezes after employers
                                                    failed to make a pay offer in 2009/10.
This compared to the then Labour
Government’s plan to cap pay awards at              The gap between pay and inflation was
1% for two years.5 The Liberal Democrats            most acute during these early years of
proposed an initial two year cap of £400 on         the national policy after both the CPI and
individual pay awards.6                             RPI increased by around 5%. The two year
                                                    freeze was succeeded by a 1% pay cap. After
Following the 2010 election, and contrary to        the 2015 general election the 1% cap was
the Conservative Manifesto policy, George           extended for a further four years.
Osborne announced that wages would be
frozen in absolute terms for two years,             The impact of this policy on staff cannot
with the exception of a flat £250 increase          be separated from the wider effects of
for workers who earned less than £21,000,           general funding reductions, which has raised
and any unconcluded pay awards would be             workloads across the public sector.
                                                6
This is especially true in Further Education,         By contrast, Northern Ireland followed
which has been hit disproportionately as an           England in 2014/15 by rejecting a
unprotected part of the Education budget,             recommended 1% consolidated increase
and reductions in real wages have therefore           in NHS wages. GMB analysis, which is
been accompanied by job losses and mergers            discussed in detail in Chapter 6, shows that
of long-established colleges.                         it is practical and affordable for Central
                                                      Government to fund an early end to the
While executive and senior management pay             pay cap policy both in England and in the
has grown, with few checks and balances,              devolved nations.
GMB members who work primarily in
the administrative and support services               Independent polling carried by Survation
have been disproportionately hurt by                  shows that the public recognises the basic
casualisation, the outsourcing of services            unfairness of the policy and that ending it
(often resulting in the adoption of                   would be popular. Three quarters of all voters
agency or zero hours contracts) and by                would support an above-inflation pay-rise
the implementation of a basic 1% (below               for public sector workers this year, including
inflation) pay rise in the 2015-16 pay round.         69% of Conservative voters. There is a clear
                                                      majority in favour of ending the policy in
Theresa May’s commitment, made shortly                every region and across every demographic
after she became Prime Minister, to                   group that was surveyed.
devise policies that would help ‘just about
managing’ families was therefore welcome,             Research by the GMB shows that public
but it is not yet clear how, or if, this pledge       sector workers could play a decisive role in
will apply to public sector workers.                  the next election. Public sector employees
                                                      outnumber the majority of incumbent MPs in
We also welcome the Labour Party’s recent             224 constituencies – over a third of the total
statement, in the context of the pay cap in           – including in 85 Conservative-held seats.
the NHS, ‘about the need to end pay restraint
… that further pay restraint for NHS staff            GMB is determined to raise the public profile
would be self-defeating and unsustainable.’7          of real-terms cuts to public sector wages
                                                      ahead of the next general election.
We are asking all political parties to now go
further and support an early end to the cap           Public-private pay differentials
not just in the NHS but across the public
sector as a whole.                                    It has sometimes been claimed that
                                                      public sector workers enjoy a significant
Although the 1% cap has been generally                premium compared to their private sector
followed across the UK, national governments          counterparts (or even that public sector
have interpreted the policy in different ways.        workers enjoy perks such as ‘gold plated
                                                      pensions’). These comparisons are not
The NHS in Wales and Scotland have become             conducted on a like-for-like basis, and there
Living Wage employers in recent years, with           is good reason to believe that any further
the costs funded externally to existing               reductions to the differential will have
budgets (unlike the cost of the National              a profoundly negative impact on public
Living Wage in NHS England, which has been            services.
paid for from within the existing budget).
                                                  7
In 2014 the Institute for Fiscal Studies found        employees is especially an issue: according
that, when adjusted for job responsibilities          to the Pay Review Body, this has lead to some
and education levels, the pay differential            NHS workers losing £449 a year in take-home
amongst men was ‘close to zero’ and amongst           pay.10
women it was around 8%.
                                                      Low to medium earners in the public
The IFS concluded that if current policies            sector are also at risk of having their
remained in force then during the current             pensions devalued by the public sector exit
Parliament ‘pay levels will fall back to levels       payments, especially in the Local Government
last seen in the late 1990s and early 2000s,          workforce.
when there were recruitment and retention
problems in parts of the public sector.’8             According to the Government’s own
                                                      modelling, a worker who retires on a final
This report further argues (in Chapter 4)             salary of as low as £25,000 could be caught
that the differential, such as it exists, is          by the cap.11
important in some areas of the country it
reflects job opportunities for women that do          There are good reasons for believing that
not tend to exist in the private sector.              the differential should not be allowed to fall
                                                      any further. The IFS has drawn attention
Although pensions are largely outside of the          to research which associated strong pay
scope of this report, it is worth noting that         competition from the private sector with
the IFS also argued in 2014 that, although            worsened hospital fatality rates and GCSE
public sector pensions continue to offer              scores.12
better value than in the private sector
(partly reflecting the decline of private             Similarly, the National Institute for Economic
sector Defined Benefit schemes over the               and Social Research recently reviewed
last twenty years), ‘recent reforms have              evidence which suggested that there was a
significantly reduced the generosity of public        link between dependence on agency staff and
sector schemes.’                                      impaired levels of patient satisfaction in the
                                                      NHS.13
New entrants in particular are paying higher
contributions for less by the way of eventual         International comparisons
remuneration. Three years ago the IFS found
that once pay and pensions are taken into             Public sector pay cuts or freezes were
account, the real average public/private              instituted in most European countries
differential (adjusted for experience and             following the crash, although the trend
education levels) was 4.6% - and this gap has         was not universal: during the period of the
been eroded further since then.9                      financial crisis public sector pay freezes
                                                      or cuts were avoided in several countries
The cost-control mechanisms within public             including Belgium, Denmark, Poland and
sector pensions will see this element of              Sweden.14
their reward package remain static as pay is
eroded.                                               However, there are signs that by persevering
                                                      with the pay cap policy until 2020 the UK is
The increase in National Insurance                    increasingly out of step with other countries.
contributions for formerly contracted-out
                                                  8
In Croatia, following a sustained period            Cabinet Office is discussing the introduction
of GDP growth, 6% cuts to public sector             of enhanced contracts to attract new staff in
wages have been reversed, and under an              IT and Government Commercial activities.
agreement with public sector trade unions
automatic pay rises will follow if GDP growth       Additional funding has recently been found
is sustained.                                       to secure pay increases for Band 3 prison
                                                    officers in the South of England.17
In Germany, after a prolonged period
of wage stagnation, public sector wage              While piecemeal improvements for
increases worth approximately 2.5% a year           some grades may be welcome, it is not
have been agreed over a two year period             a comprehensive solution to the wider
between unions and both federal and state           recruitment and retention problem in the
governments.15                                      public sector.

Pay policy in America has largely mirrored          Future Government public sector
that of the UK until recently. A two year
pay freeze was introduced, which was
                                                    pay policy
subsequently extended into a third year by
                                                    As recruitment and retention pressures
Congress against the wishes of the Executive.
                                                    mount, GMB is deeply concerned by the
Pay awards of 1% followed in 2014 and 2015,
                                                    Government’s stated intention to target
and wages were raised by an average of 1.3%
                                                    pay awards within the 1% cap in future
in 2016.
                                                    bargaining rounds within this Parliament.
The apparent similarities between US and UK
                                                    Ministers have already said pointedly that
public sector pay policies ended in December
                                                    ‘this may mean that some workers receive
2016 when President Obama announced that
                                                    more than 1 per cent whilst others receive
federal salaries would rise by an average of
                                                    less, and there should be no expectation that
2.1% in 2017, partly in recognition of the
                                                    every worker will receive a 1 per cent pay
‘significant sacrifices’ that federal workers
                                                    award.’18
had been asked to make during the period of
pay constraint.16
                                                    In some Departments, proposals have been
                                                    made to trade unions for 10% of staff to get
Recent developments                                 no rise at all and a further 20% to get less
                                                    than a 1% increase.
The pay cap has already been breached
in the course of the last year. Following           There is clearly a danger that, without
negotiations with the GMB and the other             additional funding, exceptional pay awards
ambulance trade unions (Unison and Unite)           for some staff groups will be made at the
the Department for Health agreed to fund an         expense of others, which would effectively
uprating for paramedics from Band 5 to Band         shift the problem to elsewhere in the public
6 salaries.                                         sector.

Departments have been given the flexibility
to hire civil servants to work on Brexit
outside of the normal pay structures and the

                                                9
CHAPTER 2 - IMPACT
ON WORKERS

Public sector workers are facing an                    Figure 1 – Real terms wage cuts compared to
unprecedented squeeze on their wages.                  Consumer Price Index inflation 2010 – 2017,
                                                       not including London or other cost of living
Prices are projected to rise by more than              weightings21
double the Government’s planned annual
1% pay increases over the course of this
Parliament, reducing the average value of
full-time public sector workers’ wages by a
further £4,073 by 2020.

On average, public sector salaries have lost
around a tenth of their value over the last
seven years.

The value of pay points in the NHS has
increased by just over 3% on average – less
than a third of private sector wage growth             The Department of Health has also recently
during the period. Local Government                    published its own estimates of the real terms
workers’ salaries have not been raised in real         fall in the value of NHS salaries for staff who
terms since 2008/09.                                   are at the top of their pay band between
                                                       2009/10 and 2015/16, which show an average
To calculate the value of this real terms loss         fall in the real value of those wages of around
of wages, GMB compared salary values for               10% if the assessment was extended to
typical full-time workers on the top of their          2016/17 (Figure 2).
pay band with the value of those salaries if
they had been allowed to rise in line with the         The NHS regulator Monitor warned in 2013
Consumer Price Index (Figure 1).                       that:

Although some staff will have received                 “We do not believe [the 1% pay cap] is
pay progression during this period, these              a sustainable strategy for improving
figures are broadly representative: 40% of             productivity in the NHS. Periods of wage
NHS staff in 2010 were at the top on their             restraint are generally followed by periods of
salary band19, and according to a more                 “catch up” with their trend level in subsequent
recent estimate by the National Institute              years. Capping wages for longer to keep costs
for Economic and Social Research half of all           down would be self-defeating for the sector
nursing staff have hit the top of their band.20        in the long term as it would make recruiting
                                                       and retaining good quality professionals
                                                       increasingly difficult.”22
                                                  10
Figure 2 – real terms fall in value of NHS             numbers of people to [the private] sector
salaries compared to the Consumer Price                so I am trying to negotiate on behalf of
Index23                                                the Government with people who are paid
                                                       substantially less than the people on the other
                                                       side of the table and industry is coming along
                                                       and cherry-picking the best of my team. That
                                                       is not the best way to drive value for the public
                                                       purse.”26

                                                       A number of independent warnings have been
                                                       made to the Government that continuing the
                                                       pay cap is not sustainable. Nowhere has this
                                                       been more prominent than in the NHS.

              “The Review Body system has proved its value over decades
              in balancing the interests of all the different parties – notably
              workforce, employers and government – for workforces where
              there is a strong and continuing public interest in the outcomes.”

              Lord Deighton, Treasury Minister, 2013-2015

Recruitment and retention                              NHS
Although data is not available on a uniform            Despite its insistence that the pay cap will
basis, pay dissatisfaction is mounting across          remain in place until 2020, the Department
the public sector.                                     of Health itself admits that the its pay cap
                                                       policy poses ‘risks to the NHS …including
Pay satisfaction in the NHS has fallen by 5 per        recruitment and retention, agency costs and
cent since 2010, with greater falls recorded           staff morale.’27
by staff in hard-to-fill posts.24
                                                       These concerns have been expressed for
In the Ministry of Defence, civilian staff pay         some time by the independent NHS Pay
satisfaction rates fell from 40% to 30%                Review Body (PRB). Before the last election,
between 2009 and 2016.25                               and before the Government announced its
                                                       plans to extend the pay cap policy to the
As early as 2013, Bernard Gray – then Chief            end of this Parliament, it warned that ‘as
of Defence Matérial with responsibility for            the economy recovers [pay restraint] cannot
managing half the Ministry of Defence’s                continue to be the main mechanism by which
procurement – told MPs that:                           the NHS achieves cost savings.’28

“We all know that public sector pay restraint          The Review Body has also said that:
is very strong… [but] I am losing significant
                                                  11
‘Bearing down too hard on the pay of the whole          Although Department rightly insists that
workforce, at a time when they are being                pay is not the only factor that is relevant
asked to deliver large scale transformational           for recruitment and retention, it has been
change, will not support innovation and may             sharply criticised by the Migration Advisory
well be counterproductive. … Similarly, hiring          Committee for underplaying the importance
extra staff should help with workload, but if           of pay. It concluded last year that:
that is done at the expense of maintaining
competitive pay levels for existing staff, then         ‘We are not convinced that the health and
turnover will increase, and productivity will           care sectors are employing non-EEA nurses
come under more pressure.’29                            at the lowest possible rates for reasons other
                                                        than to save money. The health sector controls
The NHS’s influential 2014 publication, the             its own supply of nurses through training
Five Year Forward View, warned that the                 commissions and yet has managed to leave
policies of the previous four years ‘will not           itself without sufficient nurses.
be indefinitely repeatable. For example as
the economy returns to growth, NHS pay will             … The sectors have, in our opinion, an
need to stay broadly in line with private sector        unrealistic view that the role of pay
wages in order to recruit and retain frontline          in recruitment and retention is only
staff.’30                                               weak. Ultimately, it comes down to cost. It
                                                        has been the desire to cut costs and to save
Despite the Forward View’s clear statements             money that has left the sectors reliant on non-
that pay constraints could no longer be                 EEA nurses to fill staffing shortfalls. We have
relied upon to deliver efficiency savings,              real concerns that these non-EEA nurses are
and despite the 2015 Conservative Party                 employed because they are a cheaper option.
Manifesto’s commitment to implement the
Forward View, the cap has remained in place.            …If we were looking at almost any other
                                                        occupation than nurses, we would find it easy
In a survey conducted by NHS Employers,                 to conclude that our sensible criteria were
93% of organisations reported that they                 not met. In which case, we would suggest to
encountering a recruitment ‘gap,’ and it was            the employers that they go and increase the
found that 78% of all vacancies that had to             number of training places to meet capacity
be advertised for more than three months                and increase staff pay to reduce the numbers
were in the field of adult nursing.31                   leaving the profession.’33

The gap is largely being filled by migrant              Agency staff
labour – and non-EU immigration rules have
been relaxed in order to accommodate this               As the NHS experiences growing difficulties
trend.                                                  with recruiting and maintaining its
                                                        permanent staff - between January 2015 and
Whereas previously only neo-natal specialists           September 2016 the number of vacancies
had been included, from November 2015                   in the NHS increased by a quarter34 - it has
all categories of nurses were added to the              become increasingly reliant on agency and
Government’s Tier 2 Shortage Occupation                 in-house bank staff.
List. The shortfalls are not limited to nurses.
Other occupations on the Tier 2 list include            This trend has been one of the main drivers
paramedics and radiographers.32
                                                   12
of increased costs and Trust deficits over the           how retention pressures are driving a growth
last seven years. In 2016 the National Audit             in agency staffing, which in turn creates a
Office found that there was ‘a statistically             vicious cycle as budgetary resources that
significant relationship’ between Trusts’                could be invested in long-term requirements
expenditure on agency staff and the scale of             are instead consumed by short-term needs.
their deficits.35
                                                         Paramedics
Even though the Government has introduced
measures to try to control the burgeoning                In December 2016 the ambulance trade
costs of agency staffing, the problem is partly          unions (GMB, Unite and Unison) secured a
a matter of supply: there are not enough new             settlement with the Department of Health
entrants to the workforce following cuts to              that will reband paramedic roles from Band 5
nursing bursaries and commissioned training              to Band 6.
places, and poor pay rates causing existing
permanent staff to take up agency work.                  This national pay increase for paramedics
                                                         follows local decisions in a number of Trusts
Although staff choose to take up agency work             to offer the higher band in order to stem the
for a variety of reasons, a recent literature            number of paramedics who are leaving the
review by the National Institute for Economic            service. This has led to intense competition
and Social Research found that:                          between Trusts to attract ambulance staff
                                                         from within the existing NHS workforce.38
‘Specialised staff, who have specialist skills in
scarce supply within the NHS or were higher-             It was also argued that the changing
graded, were more likely to cite higher hourly           roles of paramedics and the increased
pay as their motivation for undertaking agency           responsibilities they are asked to undertake
work, reflecting their ability to command                had rendered the old pay structures
higher returns and stipulate their own terms             anachronistic.
to the agencies. …
                                                         While the GMB welcomed the Department
Another study highlights that for employees at           of Health’s concession, the same arguments
the top of their pay grade (as is the case with          apply to many other staff groups.
50% of the nursing workforce), agency work
provides an attractive, and indeed the only,             Nursing has been particularly hit by post-
option to obtain higher pay.’36                          2010 cuts to commissioned training places,
                                                         the growth of agency work (as some nurses
The growing reliance on agency staff is not              chose to transfer to agencies to reduce
unique to the NHS. In 2010 an estimated 8%               stress and obtain higher pay), and increased
of public sector jobs were supplied by an                workload pressures.
agency – by 2015, that number had increased
to 13%.37                                                There is evidence that some NHS Trusts are
                                                         rebanding nurses’ pay from Band 5 to Band 6
The annual cost of temporary and contract                in order to aid recruitment and retention.39
staff to the public sector rose by £2 billion
between 2011/12 and 2014/15 (this is                     GMB believes that, as with paramedics, pay
discussed in more detail in Chapter Six).                for nurses and other NHS employees has
The NHS is, however, the clearest example of
                                                    13
failed to keep pace with either the cost of       to the National Audit Office, the number of
living or the increased workload pressures        teachers exiting the system rose by 11%
that staff face.                                  between 2011 and 2014.41

Education                                         In 2016 the Pay Review Body noted that ‘after
                                                  several years of pay restraint, the strains are
As a general union, GMB represents a              showing,’42 and argued that:
significant share of the school support staff
workforce, including teaching assistants.         ‘If current recruitment and retention trends
                                                  continue, we expect an uplift to the pay
Despite the growth in public investment in        framework significantly higher than 1% will be
support staff over the last decade, gathering     required in the course of this Parliament.’
a clear national picture is more challenging
than in the NHS.                                  The total number of pupils in the school
                                                  system rose by 5.7% between 2010 and
There are, however, strong indications that       2016, but in primary schools the growth in
the pay cap is having the same detrimental        demand was even stronger as pupil numbers
effect in schools as in other parts of the        increased by 12.7%.43
public sector.
                                                  This growth has largely been accommodated
Although support staff make up 62%                through the recruitment of additional
of the education workforce in England,            support staff: the number of teaching
the Department for Education does not             assistants increased by 12.9% between 2010
collect any information on recruitment and        and 2015.
retention pressures for school support staff
or teaching assistants.                           Classroom teacher number increased by
                                                  just 1.6% over the same period. This trend
The Department does not collect information       reflects the concern raised by our members,
on days lost to sickness (including stress),      and by external bodies like the Education
skills attained, or the prevalence of term        Endowment Foundation, that teaching
time-only contracts.40                            assistants are increasingly being asked to
                                                  function as ‘substitute teachers.’44
Despite the extremely limited nature of the
available data, it is possible to infer some      It has become more and more common for
conclusions from support staff employment         teaching assistants to face many of the same
numbers and information on salaries, not          pressures as teachers.
all of which is routinely published by the
Government.                                       For example, GMB has drawn attention to the
                                                  unacceptable risks that school support face,
Wider conclusions can also be drawn from the      including the threat of violent assault.45
School Teacher’s Review Body’s comments
where they also apply to support staff.           Official figures reflect the messages GMB
                                                  receives from its members – that teaching
Roughly 30% of teachers leave the                 assistants are being asked to play an ever
profession after five years and, according        more important role in schools, but they are
                                                  not receiving fair rewards for their efforts.
                                             14
maintained or academy sectors.
The extent of the application of the cap
across the education sector is difficult to            None of these explanations are exclusive,
assess. The cap does not technically apply             but they do point to the same recruitment
to school support staff who are classed as             and retention problems that are being
Local Government or otherwise non-Crown                experienced elsewhere in the public sector.
employees, but the policy has in practice
been adopted by a number of academy
chains.

Figure 3, which uses data released by
the Department for Education, gives an
indication of changes to average pay for
teaching assistants (compared to CPI
inflation between November 2011 and
November 2015):

Figure 3 – average full time teaching assistant
salaries46

It is notable that, on average, general
teaching assistants’ salaries have increased
at a compound rate of just 0.3% per year -
well below the nominal cap.

It is plausible that these very low average
increases are due to some academy chains
not following the national pay policy. Equally,
it could reflect a very high turnover rate
amongst teaching assistants.

It will also in part reflect the growth in Free
Schools, which offer support staff salaries
that are £2,000 lower on average than in the
                                                  15
CHAPTER 3 - EQUALITY
 AND REGIONAL ANALYSIS

In connection with its duties under the               For example, 10% of civil service
Equalities Act, the Government produced               administrative assistants and officers are
three brief Equality Impact Assessments of            disabled, compared to 4.7% of those paid on
the pay freeze/cap over the course of the             the Senior Civil Service scales.50
last Parliament (no Impact Assessment was
undertaken of the decision to extend the pay          The most distinguishing feature of the public
cap for a further four years in the current           sector workforce’s demographic is, however,
Parliament).                                          its gender balance.

The Treasury’s own Impact Assessments                 Two thirds of public sector workers are
point to some of the equalities challenges            female51, including 90% of teaching
posed by the cap, and they acknowledge that:          assistants52 and 80% of NHS workers53.
‘as the public sector workforce is more likely
to be female, Black or Black British, DDA             The Government has argued that because
disabled and Christian, in comparison to the          public sector budgets are protected from
rest of the workforce, these groups are more          wage inflation, more public sector jobs
likely to be disproportionately affected.’47          have been preserved and women are likely
                                                      to be the main beneficiaries (in 2012 David
Although the Impact Assessments are not               Cameron went as far as claiming that the
lengthy documents, they do acknowledge                public sector pay freeze ‘has actually helped
that the blunt nature of the cap does not             women.’)54
allow for adjustments on the grounds of
equalities: ‘because this policy will relate          For reasons covered in the previous Chapter,
to an average uplift, it is not possible at           such as the suppressive effect on the
this stage to determine the precise impact            permanent workforce of the growing reliance
on individuals – and therefore to design              on agency staff, this argument is difficult to
mitigations.’48                                       sustain.

According to the Impact Assessments, 3.2%             It also fails to take into account the regional
of the public sector workforce self-identifies        complexities of the public sector labour
as black or black British, compared to 2.4%           market, the effects of which, when combined
of the general workforce. 7% of public sector         with public sector job cuts, mean that women
workers are DDA-disabled, compared to 5.8%            outside of London and the South East have
in all employment.49                                  experienced an acutely negative impact.

There is evidence that, within the public             Relatively speaking, and excluding those
sector, lower paid workers are generally more         jobs that have exited the public sector
likely to be disabled.                                due to outsourcing, privatisation or other
                                                 16
reclassifications, public sector job cuts            into the private sector will not have been
in England have been disproportionately              able to find work with equivalent wages and
concentrated in the North and the South              responsibilities.
West (Figure 4).
                                                     Figure 5 – Gender pay gap between public
Jobs have been cut in the North East                 sector and private sector workers by region56
by double the national average rate. By
contrast, in net terms, London has been
relatively insulated from reductions in the
public sector headcount.

Figure 4 – net changes to public sector jobs
in thousands, excluding the effects of major
transfers55

                                                     If the pay cap had positive impact on women,
                                                     it would be reasonable to expect the gender
                                                     pay gap to have closed within the public
                                                     sector. In fact, the opposite is true.

                                                     According to ONS estimates, average full-
                                                     time female public sector salaries increased
As Figure 5 shows, public sector pay for             by just 7.4% between 2010 and 2016 whereas
women is higher on average than private              male public sector salaries increased by
sector pay for women across the country, but         8.8%. By contrast, average male salaries in
there is significant regional variation.             the private sector increased by 9.9% and
                                                     average female salaries increased by almost
Those regions that have experienced the              14%.
proportionately greatest public sector job
cuts also tend to be the regions that exhibit        This trend is despite efforts by the Pay
the greatest pay differentials between               Review Bodies to target pay awards at lower
women in the public sector and women in the          paid workers within the overall 1% envelope.
private sector.
                                                     In reality, the pay cap has had the effect
The pay gap amongst women is by far the              of ossifying an unfair pay structure at the
smallest in London (which is also the only           same time that some progress is being made
region where the pay gap is greater for men          towards closing the gender pay gap in the
than it is for women).                               wider economy.

 Again, average pay for women in the North
East has the greatest pay disparity between
sectors. It is likely that women in the North
East who have moved from the public sector
                                                17
Figure 6 – TUC estimates of pay cap related
loss of spending power by region in England57

                                                18
CHAPTER 4 - BREXIT

                “We will take back control of our money - our official EU
                bill is £350 million every week. We'll be able to spend our
                money on the public's priorities, particularly public services.”

                Boris Johnson, 22 June 2016

It has been said that ‘the sheer scale of the           measured by the Consumer Price Index, the
challenge set by Brexit for the civil service is        average public sector worker is set to lose
unprecedented in peacetime.’58                          a total of £4,073 in real terms by 2020,
                                                        of which £1,426 can be attributed to the
This is undoubtedly true for our members                additional inflation triggered by Brexit.60
in the civil service, but Brexit also poses
serious challenges for the public sector as a           As the exact form that Brexit will take
whole.                                                  remains unknown the OBR did not project
                                                        any additional inflation beyond 2019, and it
The Government has already been forced to               is likely that the true cost to public sector
breach its normal pay restrictions for Senior           workers in 2019/20 will be even higher than
Civil Servants in order to attract sufficient           estimated.
new entrants in advance of Brexit.59
                                                        The public sector pay cap was introduced on
With pay consistently emerging as the                   the assumption that inflation would remain
leading cause of dissatisfaction amongst                relatively low (although, in fact, it quickly
departmental workforce, it is likely that the           hit a high of around five per cent during
pay cap will harm the Government’s ability              2011/12). That assumption no longer holds.
to retain civil servants assigned to Brexit
as demand for their expertise builds in the             Figure 7 – real-terms cost of the cap for full
private sector.                                         time workers in selected occupations measured
                                                        by forecast Consumer Price Index, including
Brexit also poses two additional challenges             the cost of revised inflation predictions
for our members and public sector                       associated with Brexit (not including cost of
employers: inflation, and uncertainty over              living weightings)
the future of non-UK nationals who work in
public services.

Inflation
In November 2016 the OBR revised its
inflation forecasts upwards. This means that,
                                                   19
The additional inflation triggered by                 who newly registered to work in the NHS fell
Brexit looks set to increase the squeeze              by 90% compared to the previous year.62
on public sector workers’ living standards
and compound the wider recruitment and                It is clear that staffing shortages will
retention problems in the sector.                     present a profound challenge for public
                                                      sector employers post-Brexit, and that the
                                                      more restrictive the new future immigration
Non-UK nationals                                      controls prove to be the greater that
                                                      challenge will become.
GMB is proud to represent all its members
in public services, and we recognise the
                                                      Without adequate investment in training
invaluable contribution that people of
                                                      places for nurses and other key roles,
different nationalities make to those
                                                      along with an improved focus on workforce
services.
                                                      retention which must include fair pay deals,
                                                      new restrictions on immigration could have
In the NHS in particular, a combination of
                                                      a severe impact on public services including
rising patient numbers caused by cuts to
                                                      the National Health Service.
social care and reductions in nursing training
places has greatly increased the service’s
                                                      The likely labour supply shortages caused by
reliance on overseas workers.
                                                      Brexit makes it even more important that
                                                      the public sector is able to offer competitive
Concern about the future status of both
                                                      salaries in order to retain its existing
EU and non-EU nationals under a new
                                                      workforce.
immigration system is widespread in the
public sector.
                                                      Figure 8 – Non-UK nationals employed by the
                                                      NHS in England as workforce percentage, 2015
In the Chartered Institute for Professional
Development’s Autumn 2016 employers’
survey, 53% of public sector employers said
they believed that reductions to their ability
to hire EU nationals would have a detrimental
effect on their operations – the highest
negative response of any sector.61
                                                      It is clear that many people voted for the UK
                                                      to leave the European Union on the strength
According to data collected in 2015, one in
                                                      of assurances that were made about the
five NHS workers are non-UK nationals, and
                                                      priority that would be placed on future
one in twenty are citizens of the European
                                                      funding for public services.
Union (not including the UK).
                                                      Polling conducted during the closing days
Some areas of the service, such as nursing
                                                      of the campaign found that 56% of voters
and ambulance staff, are particularly
                                                      believed that the NHS would be better off
vulnerable to future restrictions on
                                                      if the UK left the EU, including a majority in
immigration (Figure 8).
                                                      every region (with the exception of Northern
                                                      Ireland where opinion was tied).63
In July 2016 – the latest month for which
figures are available – the number of nurses
                                                      As Dominic Cummings, Campaign Director for
                                                 20
Vote Leave, has written: ‘Would we have won
without £350m/NHS? All our research and
the close result strongly suggests No.’64

However, so far, these pledges have not
translated into firm commitments from the
Government.

Given the profound recruitment and
retention pressures facing public services,
pay should form a core part of any additional
funding award.

It is clear that the Referendum has rendered
the pay cap as long out of date even on its
own terms, and that providing a competitive
pay offer for public sector workers must
form a part of the Government’s post-Brexit
strategy.

                                                21
CHAPTER 5 - THE COST OF
ENDING THE PAY PINCH

  “In the last Parliament, the government exercised firm restraint over public sector
  pay to deliver reductions to departmental spending, saving approximately £8 billion.
  In light of this and continued low inflation, the government will therefore fund public
  sector workforces for a pay award of 1% for 4 years from 2016-17 onwards. This will
  save approximately £5 billion by 2019-20.”

  Summer Budget, 2016

To better understand the cost implications             GDP projections have been substituted for
of abolishing/lifting the pay cap, GMB used a          the latest (December 2016) GDP deflator
combination of information obtained from               numbers.
the Treasury and official statistics to produce
estimates for the additional expenditure               As economic growth forecasts are
that the Government would have to make in              downgraded the estimated savings achieved
order to end the pay cap early.                        by continuing the policy also decrease. On the
                                                       latest figures, the total, cumulative saving
In the 2015 Summer Budget the Treasury                 in this Parliament is therefore reduced from
stated that the pay freeze/cap saved                   £12 billion to £8.5 billion.
approximately £8 billion in the last
Parliament, and that the policy would go on            From a public accounting perspective, the
to save approximately £5 billion by 2020.              savings appear greater the longer the time-
                                                       series is continued. If the policy’s end year
According to a summary of the Treasury’s               is rebased, as the Treasury already did for
approach that has been obtained through                2015/16, then the apparent savings quickly
the Freedom of Information Act, the policy’s           reduce in value.
savings were estimated by projecting
increases to the public sector pay bill by GDP         For illustrative purposes, Figure 9 includes
growth and by the 0% and 1% caps, and then             cost estimates on a three, two, and one year
comparing the two sets of figures.                     basis for ending the policy in this Parliament.

It is possible to recreate the Treasury’s              This approach is not without its drawbacks.
figures by applying this methodology to the            Projections of wage growth on a linear basis
total public sector wage bill for the UK.              fail to account for changes to job numbers
                                                       and more dynamic factors such as reductions
In order to produce as accurate a cost                 to temporary costs and the elasticity of
estimate as possible, the original 2015                demand for public services when recruitment
                                                  22
and retention issues are addressed. The true           priorities. For example, the cost of ending
complexity of the public sector pay bill is            the public sector pay cap for civilian staff in
shown in Figure 10.                                    the Ministry of Defence is estimated to be
                                                       £250 million – roughly the same amount as
As such, it is likely that Figure 9 represents         the capital that has been set aside to fund
an overestimate of the real cost of ending             the expansion of grammar schools.67
the cap. Nevertheless, the figures do cover
all of the public sector across every nation of        GMB believes that after seven years of a
the UK.                                                gruelling pay squeeze, it’s time to put public
                                                       sector workers first.
On the basis of these estimates GMB believes
that ending the public sector pay cap is both          Figure 9 – pay cap estimated savings in this
practical and affordable. Two options for              Parliament (£bns)68
funding an end to the cap include:

1. Using the proceeds of growth

As the economy strengthens, it is vital that
the benefits of growth are shared with
everyone who has contributed to its success.
According to the OBR, the public sector
borrowing requirement for the 2017 Budget
is likely to be approximately £12 billion less
than forecast.65
                                                       Cost of the public sector pay bill
This single in-year saving would be enough to
                                                       At face value, it may appear that the
fund an end to the public sector pay sector
                                                       Government’s reduction in the public sector
across the course of this Parliament even
                                                       headcount and pay restraint policies has not
based on the higher range Treasury cost
                                                       had a meaningful impact on wages; the total
estimates.
                                                       bill for wages and associated costs fell by
                                                       only 1% in real terms between 2009/10 and
2. Reversing the cut to corporation tax                2014/15 (Figure 13).

Using the Treasury’s latest GDP projections            This headline figure disguises a sharp fall
reduces the cost of ending the policy to               in wages and salaries for permanently
around £8.5 billion.                                   employed public sector workers, which has
                                                       been reduced by 16% (or £26.5 billion) in real
This is equivalent to the forecast revenue             terms.
loss that will be incurred by the forthcoming
cuts to Corporation Tax rates.66 The                   In fact, the main drivers of public sector
Government could fund an end to the pay cap            costs have been increased pension schemes,
by reversing this decision.                            the costs of which have been increased by
                                                       policies such as academisation and the future
Ultimately, continuing or ending the cap is a          value of which has been steadily reduced
political decision that reflects Government            due to, and a growing reliance on temporary
                                                  23
employees.

Expenditure on temporary and contract staff
increased by 28% (or £2 billion) between
2011/12 and 2014/15.

It is likely that the Government’s growing
reliance on more expensive contractors,
agency staff and consultants reflects
broader recruitment and retention problems
within the permanent workforce.

Despite efforts to cap the cost of agency
staff within the NHS, this trend is likely
to continue due to the pressures that
preparations for Brexit are placing upon the
civil service and the wider public sector.

Although it is not possible to predict what
pay increases liberated Pay Review Bodies
would award, precedent suggests that
the cost to the public purse would not be
unreasonable.

In the years leading up to 2010, pay awards in
the NHS averaged around two and a half per
cent, and did not exceed 2.75 per cent in any
year (historical comparisons are explored in
the appendix).

Figure 10 – total UK public sector wage bill
(£bs)69

                                                 24
APPENDIX

 COMPARISON WITH HISTORIC
 PAY CONSTRAINT POLICIES
Public sector wage caps have been an                   unpopularity of the Major administration.
intermittent feature of post-war economic              According to the Social Market Foundation,
policy. Wage controls are most popularly               ‘the Major government used its monopoly to
associated with the Labour and Conservative            drive public sector wages substantially below
governments of the 1970s, but there are                market levels, but by 1999 there were severe
examples from other decades.                           staff shortages, as new workers shunned the
                                                       public sector in favour of the private.’71
Most caps did not attempt to limit salary
increases below the rate of inflation, however,        The issue became increasingly politicised as
and those that did are generally regarded as           the 1997 election approached, and the public
failures.70 As new research from the House of          sector workforce suffered from a ‘double
Commons Library shows, the closest parallels           whammy’ of failing to attract new entrants
available are with the policies pursued by             and experienced workers seeking early
John Major’s government between 1992 and               retirement.72
1997.
                                                       The 1997 – 2010 Labour government did
For the first two years of his premiership             relax public sector pay restrictions once the
Major broadly continued Thatcher’s ‘merit,             period of adherence to its predecessor’s
skill and geography’ incomes policy, whereby           spending plans ended. Some caps were
there were no formal, centralised controls on          imposed in the last year of the Labour
settlements and the emphasis was placed on             administration on the minority of public
individual sector needs and affordability.             sector workers who had not been covered
                                                       by the three year pay deals which had been
A 1.5% cap was imposed in November 1992,               agreed in 2007 (before the financial crash).
which one year later was replaced by a policy          Pay settlements during these years cannot
of self-financed pay settlements. In practice          be considered excessive, and in the NHS they
this meant that all pay awards had to be               never exceeded 2.75% under Agenda for
paid for through efficiency savings or job             Change arrangements (Figure 12).
losses. As with now, the restrictions on wage
settlements took place against a backdrop of           An academic survey of all Pay Review Bodies
demands for increased general funding and              between 1979 and 2006 did not find that
rising demand for public services.                     recommendations rose to an unreasonable
                                                       level once the Major-era restrictions had
This policy directly contributed to the public         been lifted (Figure 13).
                                                  25
Figure 11 - Public sector pay constraint policies 1979 to 202073

Conservative Government elected May 1979

 May 1979 – January 1980                 No limit.
 January 1980                            14 per cent limit for public services.
 November 1980                           6 per cent limit for local government from Nov 1980.
 February 1981                           6 per cent limit for central government. A separate pay
                                         provision figure set for the first time. Limit to cover
                                         settlements from 1 Nov 1980 to 31 March 1982.
 September 1981                          4 per cent limit from due settlement dates 1982 - 1983.
 October 1982                            3.5 per cent limit for central government. 1983-1984.
 September 1983                          3 per cent limit for central government. 1984 - 1985
 February 1984                           3 per cent policy tightened. No offsetting of manpower
                                         savings.
 November 1986–Nov 1992                  No formal limits. Policy of ‘merit, skill and geography’.
 November 1992–Nov 1993                  Chancellor announces 1.5 per cent limit for the public
                                         services for the year from November 1992 to November
                                         1993.
 November 1993 – Nov 1996                Policy to offset public sector pay increases by
                                         improvements in efficiency or productivity with all
                                         increases to be self-financing.
 November 1996                           Chancellor announces above policy to be continued.

Labour Government elected

 1997                                    Pay settlements to be ‘affordable within existing spending
                                         plans’
 1998                                    No explicit pay policy, but awards to be consistent with
                                         the Government’s inflation target and affordable.
 1999 to 2008                            No explicit policy, but public spending including pay should
                                         be consistent with the Government’s inflation target and
                                         affordable within Departmental Expenditure Limits. It
                                         should also be used to support pay and organisational
                                         modernisation.
 October 2009                            The public sector should show ‘leadership in pay restraint’.
                                         Pay settlements of up to 1 per cent for public sector
                                         workforces excluding staff on 3-year pay agreements. No
                                         pay rise for senior staff. No limit for the Armed Forces.

Coalition Government formed May 2010

 2011-12 – 2012-13                       Two year pay freeze for the public sector, with the
                                         exception of those earning £21,000 or less. Pay increases
                                         of at least £250 for those earning £21,000 or less.
 2012 – 2015                             Pay restraint. Pay awards that average 1 per cent per year.

Conservative Government elected

 2015 – 2020                             1 per cent average pay awards extended to 2020.

                                                               26
Figure 12 – Changes to historic NHS (Agenda for Change) pay rates74

Figure 13 – Overview of Pay Review Bodies’ recommendations, percentage changes on pervious years 1971 to 200675

                                                            27
ENDNOTES

1.   http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/
     Commons/2017-02-01/62652/
2. https://www.tuc.org.uk/industrial-issues/public-sector/nurses-teachers-and-firefighters-facing-falls-thousands-real-
   pay-end
3.   https://www.etuc.org/press/2017-year-pay-rise#.WLbkXlWLSUk
4. Conservative Manifesto 2010, page 8: https://www.conservatives.com/~/media/Files/Manifesto2010
5. Pre-Budget Report, 09 December 2009: https://www.publications.parliament.uk/pa/cm200910/cmhansrd/cm091209/
   debtext/91209-0006.htm
6. Liberal Democrat Manifesto 2010, page 16: http://www.politicsresources.net/area/uk/ge10/man/parties/libdem_
   manifesto_2010.pdf
7.   https://hansard.parliament.uk/commons/2017-01-30/debates/86C7A0AE-7CA2-4142-9B4A-A03DA115C397/
     AgendaForChangeNHSPayRestraint
8. https://www.ifs.org.uk/uploads/publications/comms/r97.pdf
9. https://www.ifs.org.uk/uploads/publications/bns/bn151.pdf (page 27)
10. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/506030/54488_Cm_9210_NHS_
    PRB_2016_Web_Accessible_NEW.PDF (page 18)
11. https://www.publications.parliament.uk/pa/cm201516/cmhansrd/cm160202/debtext/160202-0004.htm#160202-0004.
    htm_spnew14
12. https://www.ifs.org.uk/uploads/publications/comms/r97.pdf (page 29)
13. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/592131/NIESR_agency_working_
    report_final.pdf (pages 106 - 107)
14. www.research.mbs.ac.uk/ewerc/Portals/0/docs/UK-national%20report.pdf
15. http://www.reuters.com/article/us-germany-wages-public-sector-idUSBREA301PL20140401; https://www.thelocal.
    de/20160430/german-public-workers-dispute-settled
16. https://www.documentcloud.org/documents/3234866-2016payraise.html
17. https://www.gov.uk/government/news/12m-pay-boost-to-strengthen-prison-frontline-and-attract-new-recruits
18. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/539339/CST_letter_to_NHSPRB_chair.
    pdf
19. http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/
    Commons/2017-02-20/64685/
20. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/592131/NIESR_agency_working_
    report_final.pdf (page 114)
21. Salary information taken from Agenda for Change and Local Government National Joint Council pay scales.
22. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/284044/ClosingTheGap091013.pdf
23. http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/
    Commons/2017-02-20/64685/
24. http://www.nhsstaffsurveys.com/Page/1006/Latest-Results/2015-Results/
25. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/569895/Civil_Service_People_
    Survey_2016_-_Departmental_Trends__V2_.pdf
26. Evidence to the Defence Reform Bill Public Bill Committee, 05 September 2013: https://www.publications.parliament.uk/

                                                           28
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